Eli Lilly Pays New Hampshire Doctors Thousands for Speaking

Eli Lilly paid 14 New Hampshire health care providers about $110,000 in speaking and consulting fees in the first quarter of this year.

Almost 80 percent, or $85,000, of that money went to five physicians who work for Dartmouth Hitchcock.

Four of them, all psychiatrists, are also on the faculty of Dartmouth Medical School.

Dartmouth allows its employees to perform professional services, including speaking, for drug companies.

Carl1: “Appropriate relationships between pharmaceutical companies and device makers and academic physicians are important to the advancement of science and to the advancement of care made available to the public.”

That’s Carl Denatteo, chief quality and compliance officer for Dartmouth Hitchcock.

But Dartmouth does cap the compensation its employees can accept.

Its conflict of interest policy says employees may not earn more than $30,000 in a single year from the medical industry.

But Eli Lilly paid two psychiatrists more than $30,000 each, just in the first quarter.

Neither the psychiatrists nor department chair Alan Green, who is required to approve speaking engagements, returned repeated phone calls.

In addition, the bulk of Eli Lilly’s compensation was for talks discussing the safety and efficacy of its drugs.

The FDA labels these presentations as promotional talks.

For such presentations – common to all of the major drug makers – the pharmaceutical company provides speakers with a script.

Eli Lilly spokesperson Carol Puhl says federal regulations do not allow speakers, no matter their expertise, to depart from the corporate scripts.

Puhl1: “This information is regulated by the FDA and so we have to be very careful that the information that is being communicated is accurate and is on label.”

And that’s a problem for Dartmouth’s Carl Dannateo, the compliance director.
He doesn’t think it’s appropriate for doctors to give promotional, scripted talks for drug companies.

Carl: “When there’s a direct relationship like that, I think it’s legitimate for people to say gee, he’s working for the drug company, so probably saying stuff that they want him to say.”

And that doesn’t sit well with Danatteo.

Carl: “Some institutions have outright banned it. I think that’s the question in front of us right now that we are going to be engaging with our faculty here at the medical center, at the college and at the medical school to have an open discussion and dialogue about.”

Indeed, fourteen medical schools have banned the practice and other med schools and hospitals are struggling with their policies now.

The American Psychiatric Association is also pushing for more rigorous ethics policies.

Dr. James Scully is the APA’s CEO and chief medical officer.

Scully1: The policy we have passed this past year for ourselves as an association is to phase out the funding of any of our educational programs by the pharmaceutical industry and we’ve begun that.”

Scully says the APA has no ability to mandate ethics policies for its individual members.

However, he frowns on speakers’ bureaus.

Scully5: “We’re in a market-based economy and there’s nothing illegal or immoral for somebody to work for a drug company and say I am an employee of the drug company and I’m here to sell you drugs. I’m not sure that’s the role of the physician, personally, and it’s certainly marketing and not education, that’s our concern.”

One reason for the heightened attention is because drug makers are beginning to disclose the names – and compensation -- of their speakers.

Merck plans to publish its own speaker database late this year; Pfizer will follow early in 2010.

Dartmouth’s Carl Dannateo:
Carl: “All the information’s going to be out there.”

Currently, drug companies are publishing the information voluntarily or, like Eli Lilly, as part of legal settlements.

But mandatory disclosure could become law under the health care overhaul bills currently being debated in Congress.